What is HPV?

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the world.

There are over 100 types of HPV. Some HPV types infect the genital area and may cause warts, i.e. “low-risk” (lr) HPV, types 6 and 11. Other HPV types may cause abnormal changes in your cells, these are “high-risk” (hr) HPV – most often types 16 and 18 – and can lead to cancer.

Most HPV infections are thought to clear naturally and do not cause health problems.

Are men at risk from HPV?

HPV is an extremely common infection and most men are infected with HPV at some time in their lives. Infection with HPV is believed to occur quickly after sexual debut and the rate of infection in males does not appear to decline with age.

How does HPV affect males?

In men, HPV can affect the ano-genital area and also the throat, in the form of genital warts, penile cancer, anal cancer and oropharyngeal (throat) cancer.

While HPV is a very common STI, genital warts are uncommon, and HPV-related cancers are rare. Infection with hr-HPV places you at risk of developing HPV-related cancers, however the likelihood of an infection progressing to cancer is unknown but thought to be low.

HPV and penile cancer

HPV and penile cancer HPV-related penile cancers most often affect the ‘head’ of the penis and are rare. It is reported that penile cancer is about 10 times less common than cervical cancer among women. Penile cancer is generally diagnosed in men over the age of 30 years and most commonly among those over 70 years.

Risk factors for HPV-related penile cancer include smoking, not being circumcised, having a previous diagnosis of genital warts, having a previous diagnosis of an STI, and number of sexual partners.

HPV and throat cancer

Cancers affecting the throat, and in particular the tonsils and back of the tongue, are becoming more common, especially in men. Whereas cancers in this area have traditionally been a result of smoking and alcohol intake, increasingly they are caused by HPV. The types of HPV which cause throat cancer are the same as those which cause genital tract cancer, and in the majority of cases of HPV-associated throat cancer the virus is thought to be transmitted sexually, especially through oral sex.

These cancers may present with persistent throat pain and difficulty swallowing, but commonly the first sign of the disease is a lump in the neck.

HPV and anal cancer

HPV-associated anal cancers are also becoming more common in both women and men. In particular, gay, bisexual and other men who have sex with men (GBM) are most at risk. HPV-associated anal cancer is now believed to affect GBM over 20 times more than heterosexual men.

HPV and males who are immunocompromised or living with HIV

Men who are taking pharmaceuticals that suppress the immune system or who are living with HIV are at particular risk from HPV infection and developing HPV-associated cancer. A compromised immune system is less able to detect and fight the HPV virus.

Of particular concern is the burden of HPV-associated anal cancer experienced by GBM living with HIV, which is thought to be 100 times greater than the general population.

It is recommended that all males living with HIV, and particularly GBM living with HIV, undergo regular health checks including a digital anal rectal exam to look for signs or symptoms that may indicate HPV-associated cancers.

HPV and condom use

HPV is transmitted by direct skin-to-skin contact and therefore condom use during sexual intercourse can provide some protection against infection. However, as condoms do not cover the entire skin surface that comes into contact during sexual intercourse, they cannot offer 100% protection.

HPV and vaccination

Vaccination is most effective when given prior to HPV infection, i.e. before sexual debut. However, some studies have shown that even men who have been exposed to HPV can receive some benefit from vaccination.

Gardasil, the HPV vaccine licensed in New Zealand, is highly effective at reducing the risk of genital warts in all male recipients between 16 and 26 years old. Gardasil has also proven to be effective at preventing pre-cancerous lesions and anal cancer related to HPV among GBM between 16 and 26 years old.

Men over the age of 26 may also still benefit from vaccination as they may not have acquired all the strains covered by the vaccine.

In New Zealand, Gardasil is currently only available free for males with HIV aged under 26 years and young women. Though it is not funded, it is recommended for GBM up to the age of 26 years, and boys and young men under the age of 20 years.

If you are outside the currently funded groups, discuss options for vaccination with your GP. The cost for three doses will vary, but is approximately $500.